Provider Demographics
NPI:1558452052
Name:PANGANIBAN, MAUDE I (DC)
Entity Type:Individual
Prefix:DR
First Name:MAUDE
Middle Name:I
Last Name:PANGANIBAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:MAUDE
Other - Middle Name:INEZ
Other - Last Name:FUJINAKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:68 S KAINALU DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2717
Mailing Address - Country:US
Mailing Address - Phone:808-263-7799
Mailing Address - Fax:
Practice Address - Street 1:68 S KAINALU DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-263-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000QCCBKMedicare ID - Type Unspecified
HIT41249Medicare UPIN